The National Heart, Lung, and Blood Institute (NHLBI) of the National Institutes of Health has approved the award of 13 contracts to local organizations across the country to develop, implement, and test science-based approaches to improve asthma control using evidence-based national guidelines for diagnosing and managing asthma.
The two-year contracts, which total $1.3 million, will be administered by the Academy for Educational Development, based in Washington, D.C., which serves as a contractor for the NHLBI's National Asthma Control Initiative (NACI).
The NACI is a new effort to strengthen collaborative efforts among patients and families, health care providers, and other stakeholders committed to improving the management of asthma – a common and often disabling condition that affects some 23 million Americans, including seven million children under the age of 18.
Each contract will provide insight into practices that can enhance asthma control by implementing at the community level the evidence-based recommendations from two reports published by the National Asthma Education and Prevention Program (NAEPP): the Expert Panel Report 3-Guidelines for the Diagnosis and Management of Asthma (EPR-3), and its companion, the Guidelines Implementation Panel (GIP) Report.
"The guidelines give us the best that science has to offer about how to diagnose and control asthma, but unless health care providers, patients, and others integrate the recommendations into their programs and day-to-day routines for managing asthma, we will fall short of our potential to improve public health," said James P. Kiley, Ph.D., director of the NHLBI Division of Lung Diseases. "The National Asthma Control Initiative's 13 demonstration projects will give us new strategies and practical tools to put the guidelines into practice in a variety of community settings. Taken together, these projects will help us make a difference in asthma control."
The NAEPP is a 20-year-old collaborative effort coordinated by the NHLBI and composed of scientific, professional, governmental, and voluntary organizations to enhance the quality of life of people with asthma and to reduce asthma-related illnesses and death. In October 2008, the NAEPP established the NACI to further advance the implementation and dissemination of guidelines for the diagnosis and management of asthma.
Each of the new demonstration projects will receive approximately $100,000 over two years to implement and evaluate strategies to improve asthma control. The projects include a range of asthma interventions in diverse communities, including rural, urban, or suburban settings. Strategies target health care providers, adult and pediatric patients, or patients' families, school personnel, and others who play a role in helping patients manage asthma. Projects address, for example:
- reducing asthma triggers in the home and at school;
- providing Web-based training programs and in-person educational outreach for health care providers, patients, parents and other childcare providers, and educators;
- helping patients and parents monitor and improve asthma control through symptoms diaries and asthma action plans; and
- developing pilot programs to improve systems of care, such as a standardized electronic assessment form to improve communication between emergency care providers and primary care physicians to better coordinate patient care and reduce emergency room visits by asthma patients.
The 13 contracts have been awarded to:
- Asthma Allies, Albuquerque, N.M.
- Boston Public Health Commission
- Children's Research Institute, Washington, D.C.
- Dorchester House Multi-Service Center, Dorchester, Mass.
- HHC Woodhull Medical and Mental Health Center, New York City
- Los Angeles Unified School District
- Medical Care Development, Calais, Maine
- Medical Society of Virginia Foundation, Richmond
- Michigan Department of Community Health, Lansing
- Mission Healthcare Foundation, Asheville, N.C.
- National Respiratory Training Center, Suffolk, Va.
- South Bronx Asthma Partnership/Bronx-Lebanon Hospital, New York City
- University of California, San Francisco
Asthma accounts for more than 10 million missed work days and almost 13 million missed school days each year.
"Our goal is to help people who have asthma lead longer, healthier, and fuller lives, thereby reducing asthma's toll on those who have it. These demonstration projects are aimed at tackling different barriers to quality asthma care, so patients and their families can improve asthma control—and be active at work, school, and play," said Diana Schmidt, M.P.H., NAEPP coordinator for the NHLBI.
Outcomes from the demonstration projects will be shared through the NACI with health care providers, patients, families and other caregivers, and communities to promote the adoption of asthma guidelines and improve the quality of asthma care nationwide. The NACI will bring together organizations from local, regional, and national levels to share best practices, leverage resources, identify new directions, and create learning opportunities. In addition to coordinating the 13 demonstration projects, the NACI will build a national partnership program and an asthma championship program.
Published in 2007, EPR-3 provides guidance for selecting treatment based on a patient's individual needs and level of asthma control. The recommendations were developed by a committee of 18 unpaid experts chosen for their scientific and clinical knowledge and experience. The guidelines emphasize that while asthma can be controlled, the condition can change over time and differs among individuals and by age groups. Thus, it is important to monitor regularly the patient's level of asthma control so that treatment can be adjusted as needed.
A diverse group of 17 national experts in asthma policy, clinical practice, research, public health, and education reviewed the expert panel's recommendations to identify priority messages to improve implementation of the guidelines. Known as the Guidelines Implementation Panel, this group of asthma guideline end-users emphasizes that asthma patients and health care providers should:
- Use inhaled corticosteroids to control asthma, as appropriate
- Use asthma action plans
- Assess asthma severity
- Assess asthma control
- Schedule follow-up visits
- Control environmental factors.
Expert Panel Report 3-Guidelines for the Diagnosis and Management of Asthma (EPR-3)
Guidelines Implementation Panel Report